"I wouldn't do it because they're not sure," said the 50-year-old Webster woman.

Understanding a patient's values, beliefs and behaviors — and then providing care in a way that meshes with that individual's social, cultural and language needs — is seen as one way to reduce health disparities.

The practice is called cultural competency. It is often referred to when discussing different health outcomes between whites and people of color.

Cultural competency is not color-blind care. Rather, it's care that acknowledges that provider and patient may have different experiences or different goals for treatment.

But lack of diversity among providers and poor communication with patients can get in the way of making decisions together. To get around obstacles, the Race and Health Disparities workgroup of Facing Race = Embracing Equity (FR=EE) is working to improve the doctor-patient relationship.

"It's not about, 'You're racist,' " said Candice Lucas, director of Community Health Services for the Center for Community Health at the University of Rochester Medical Center. "We're not in post-racial America, regardless of the color of our president."

The FR=EE workgroup has been meeting for several months and plans focus groups of health professionals and community members.

"We're all responsible," Lucas said. "As individuals, as patients, we have to be more responsible for our own health. We have to learn how to ask questions. Make sure we leave with the understanding of what we're being told."

FR=EE is tackling what's been seen as a longstanding concern.

In 1999, the Office of Minority Health outlined steps to address cultural needs because of the effect on health care — and health. Shortly thereafter, the federal Agency for Healthcare Research and Quality issued standards for how the government and private sector persuade providers to realize that cultural differences can be barriers to care.

Dukes-Smith cut through the jargon of the recommendations and regulations.

"Working to improve that relationships is knowing other than just the health data," she said. "It's knowing that person's surroundings, how they feel, how they think. What lifts them up. It's more listening."

There's an assumption that the doctor-patient relationship is more likely to flourish when doctor and patient look like each other.

"I think a lot of my patients who are African-American make a connection," said Dr. Linda Clark, who was the medical director at the Anthony Jordan Health Center and now has a private practice in occupational medicine. She also treats addictions.

Dr. Marino Tavarez is a native of the Dominican Republic and practices primary care at Clinton Family Medicine, where about 80 percent of the patients are Hispanic.

"We deal with a lot of barriers to care," he said. "A lot of our patients have difficulty expressing themselves in a language that may not be their first language."

While interpreter services are available when doctor and patient speak different languages, Tavarez said he can provide better care because he speaks Spanish and is part of the Caribbean culture. It's particularly important with sensitive concerns such as mental health and substance abuse.

"They confide in me," he said. "They are appreciative."

He said patients know it's rare to find a doctor from a minority population.

In New York, active physicians are less diverse than the general population, according to the Center for Health Workforce Studies at the University of Albany. Minority physicians are more likely to be in primary care, practice in federally designated primary care shortage areas and have a higher percent of Medicaid patients compared with all other physicians.

Dr. Cheryl Kodjo is associate dean at the University of Rochester School of Medicine and Dentistry. She leads the medical school's diversity curriculum, which encourages students to reflect on their biases and appreciate the experiences of their patients.

"For some groups, there is a very real distrust of the health care system," Kodjo said. "You have to be more deliberate in your interactions. 'Tell me what you're looking for. Tell me what you expect from the health care system and how can I adapt within reason.'"

Adrianne Chesser, student representative to the diversity committee, said students are learning that health and health care are more than medicine.

"It's a whole social situation," she said. "When a patient comes to you, they are not just their disease. They are their history, their job, their experience, their interests, their life."